No.2 2014.2.21 消化系统七年制1

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X线钡餐造影检查方法
禁忌证 contraindications
Forbidding from the following diseases
完全性肠梗阻 the completely intestines obstruction 胃肠道穿孔 the perforation of gastrointestinal tract 急性胃肠道出血 the acute bleeding of gastrointestinal tract
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The mucosa in the greater curvature like sawtooth, the other is very smooth. 胃体大弯呈锯齿状 其余部分光滑整齐
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胃
• • • • 分部(胃底、胃体、胃窦、大弯、小弯) 形状(牛角型、钩型、瀑布型、长型) 轮廓(胃体大弯呈锯齿状，余光滑整齐) the mucosal folds 粘膜皱襞(胃底、胃体、 胃窦) • 胃小区、胃小沟 • 蠕动(一般可同时见三个蠕动波，胃窦为 整体向心性收缩)
is in “real-time” and is like a video. It is done
intermittently throughout the examination. Images are shown on a monitor. • “Spot films” are x-ray films (radiographs) taken at specific times and of a specific area of the bowel
• The stomach is “screened” using X-rays
• Spot films are then taken patient in different positions
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胃stomach
• subdivision 分部(胃底fundus、胃体body、胃 窦antrum、大弯greater curvature、小弯lesser curvature) • 形状(牛角型、钩型、瀑布型、长型) • 轮廓(胃体大弯呈锯齿状，余光滑整齐) • 粘膜皱襞(胃底、胃体、胃窦) • 胃小区、胃小沟 • 蠕动 ( 一般可同时见三个蠕动波，胃窦为整体 向心性收缩)
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steerhorn
cascade
longitypical
fishhook
牛角形:位置张力均高，横位，胃角不明显，多见于肥胖者 钩形:张力中等，胃角明显，胃下极于髂嵴水平 瀑布型 : 胃底囊袋状向后倾，胃泡大、体小，钡先入胃底，充 满后溢入胃体 长型:位置张力均低，胃腔上窄下宽呈水袋状，胃下缘位置低
消化系统 digestive system
The First Affiliated hospital of Nanjing Medical University 南京医科大学第一附属医院 刘希胜
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digestive system
一、digestive tract (空腔脏器，organs with cavity or lumen) esophagus, stomach, small and large bowel 二、digestive gland liver, gall, pancreas and the spleen
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粘膜相上，胃皱襞
间沟内充满钡，呈条
纹状致密影，皱襞则 呈条纹状透亮影；胃
底部呈网状；小弯侧
与小弯平行，胃窦部 与舒缩有关，收缩时 为纵行，舒张时为横 行。胃皱襞形态可变。
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胃
• • • • • 分部(胃底、胃体、胃窦、大弯、小弯) 形状(牛角型、钩型、瀑布型、长型) 轮廓(胃体大弯呈锯齿状，余光滑整齐) 粘膜皱襞(胃底、胃体、胃窦) 胃小区gastric area、胃小沟gastric groove • 蠕动(一般可同时见三个蠕动波，胃窦为 整体向心性收缩)
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消化道检查方法 The examination methods
• X- ray 普通检查 • 钡剂造影(barium study)
• 血管造影(angiography）
• CT computed tomography • MRI magnetic resonance imaging • 超声Ultrasonography • 核医学 nuclear medicine (SPET PET)
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钡剂检查注意： The attentions about barium studies
透视与摄片结合 fluoroscopy combined with the films 形态与功能并重 the conformation is important as well as the function 触诊与透视并重 the palpation and the fluoroscopy are all important
正常影像
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Barium swallow
食管吞钡检查
How it is done?
• Swallow baking soda crystals (to make gas) with little water
• Drink the barium liquid barium concentration is about 200% • The passage of barium is “screened” with x-ray (patient standing, 正位、右前斜位、左前斜位、左侧位) • Spot X-ray films are taken
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DSA 肠系膜上动脉造影

血管造影检查 DSA 适用征：血管性病变、出血、富血供肿瘤
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CT检查
扫描技术与参数 检查前准备 CT扫描参数 平扫与增强 CT仿真内窥镜 扫描参数 重建

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MRI检查 超声检查：超声内镜 核医学
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The normal manifestations
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食管esophagus
observations
• • • • 充盈相 barium filling phase 粘膜相 mucosal phase 双对比相 double contrast phase 蠕动波 the first, the second and the third squirm wave • 食管胃连接部 esophagogastric junction
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Barium swallow 食管吞钡检查
Why gas?
To help distend the esophagus and produce double contrast effect (for better definition of small mucosal abnormalities)
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CT表现
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MRI表现
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Barium meal 胃钡餐检查
How is it done?
• Swallow baking soda crystals (to make gas) • Drink the barium liquid lying down on a x-ray couch • Patient is gently rolled around to coat the walls of the stomach and duodenum

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牛角型steerhorn stomach
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钩型fishhook stomach
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瀑布型 cascade stomach
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长型 longitypical stomach
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胃
• 分部(胃底、胃体、胃窦、大弯、小弯) • 形状(牛角型、钩型、瀑布型、长型) • the outline 轮廓(胃体大弯呈锯齿状，余光滑整 齐) • 粘膜皱襞(胃底、胃体、胃窦) • 胃小区、胃小沟 • 蠕动 ( 一般可同时见三个蠕动波，胃窦为整体 向心性收缩)
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X- ray
消化道检查方法 The examination methods
腹部平片(plain film radiograph often serve as scout films prior to contrast studies)
1) 立位腹部平片 2) 仰卧前后位 3) 倒立侧位
透视(fluoroscopy, given up)
very smooth.
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The third squirm wave was begun the esophagus under the aorta arch, the wall may be like wave or saw, or may be spasmodic contraction. It will keep on several seconds or several minutes. 第三收缩波常见于食管下段，可表现为食 管边缘呈不均匀的波浪状或锯齿状，也可 表现为一段食管呈痉挛性收缩，一般持续 数秒至数分钟。
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Barium/Contrast studies How to do?
• All utilize X-rays to image the bowel • “Screening” (fluoroscopy) is used to view the passage of barium/contrast through the bowel. This
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barium filling phase
右前斜位
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mucosal phase
three or four mucosal line 3~4条粘膜线
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